2024 -- S 2345 | |
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LC005003 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2024 | |
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A N A C T | |
RELATING TO STATE AFFAIRS AND GOVERNMENT -- RHODE ISLAND INDIVIDUAL | |
MARKET AFFORDABILITY ACT OF 2024 | |
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Introduced By: Senators Miller, Ujifusa, DiPalma, Valverde, Lauria, and DiMario | |
Date Introduced: February 12, 2024 | |
Referred To: Senate Finance | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Title 42 of the General Laws entitled "STATE AFFAIRS AND |
2 | GOVERNMENT" is hereby amended by adding thereto the following chapter: |
3 | CHAPTER 157.2 |
4 | RHODE ISLAND INDIVIDUAL MARKET AFFORDABILITY ACT OF 2024 |
5 | 42-157.2-1. Short title and purpose. |
6 | (a) This chapter shall be known and may be cited as the "Rhode Island Individual Market |
7 | Affordability Act of 2024." |
8 | (b) The purpose of this chapter is to create a state affordability program to reduce out-of- |
9 | pocket costs for low- and moderate-income consumers enrolled in health insurance coverage |
10 | through the Rhode Island health benefits exchange. |
11 | (c) Nothing in this chapter shall be construed as obligating the state to make general |
12 | revenue appropriations to support the state affordability program. |
13 | 42-157.2-2. Definitions. |
14 | As used in this chapter: |
15 | (1) "Affordability program" means a program to improve affordability for health care or |
16 | health insurance coverage as implemented by the board established by § 42-157.2-6. |
17 | (2) "Assessment" means the health insurance affordability assessment established by § 42- |
18 | 157.2-5. |
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1 | (3) "Board" means the health insurance affordability board established by § 42-157.2-7. |
2 | (4) "Commissioner'' means the commissioner of the office of the health insurance |
3 | commissioner. |
4 | (5) "Cost-sharing reduction" means the program set forth in 42 U.S.C. § 18071 by which |
5 | certain individuals eligible to purchase health insurance coverage through the exchange are entitled |
6 | to purchase a plan with an adjusted actuarial value to lower out-of-pocket expenses. |
7 | (6) "Director" means the director of the Rhode Island health benefits exchange. |
8 | (7) "Exchange" means the Rhode Island health benefits exchange established within the |
9 | department of administration by § 42-157-1. |
10 | (8) "Federal poverty line" has the same meaning as "poverty line" as set forth in 42 U.S.C. |
11 | § 9902(2). |
12 | (9) "Health insurance carrier" or "carrier'' has the same meaning as set forth in § 27-18.5- |
13 | 2. |
14 | (10) "Health insurance coverage" has the same meaning as set forth in § 27-18.5-2. |
15 | (11) "Household income" has the same meaning as set forth in 26 U.S.C. § 36B(d)(2). |
16 | (12) "Individual market" has the same meaning as set forth in § 27-18.5-2. |
17 | (13) "Office of the health insurance commissioner" means the entity established by § 42- |
18 | 14.5-1 within the department of business regulation. |
19 | (14) "Premium tax credit" means the refundable tax credit available pursuant to assist |
20 | certain individuals in purchasing health insurance coverage through the exchange. |
21 | (15) "Program" means the individual market affordability program established by § 42- |
22 | 157.2-3. |
23 | (16) "Program fund" or "fund" means the fund established by § 42-157.2-4. |
24 | (17) "State" means the State of Rhode Island. |
25 | 42-157.2-3. Establishment of the Rhode Island individual market affordability |
26 | program. |
27 | (a) The director is authorized to establish a state-based affordability program, to be known |
28 | as the Rhode Island individual market affordability program: |
29 | (1) To provide for improved affordability for individuals who purchase health insurance |
30 | coverage through the exchange; |
31 | (2) That is consistent with state and federal law. |
32 | (b) The program is intended to mitigate the impact of high and rising healthcare costs for |
33 | low- and middle-income Rhode Islanders who purchase health insurance coverage through the |
34 | exchange by reducing out-of-pocket costs through expanded affordability programs. |
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1 | (c) The director is authorized, based on recommendations advanced by the board, to |
2 | implement affordability programs and direct payment to carriers to reduce the cost of health |
3 | insurance coverage purchased through the exchange, and to improve the actuarial value of health |
4 | insurance coverage, for individuals determined eligible for state-based subsidies. |
5 | (d) The director, in consultation with the commissioner, the secretary of the executive |
6 | office of health and human services, and the Medicaid director, shall collaborate to identify any |
7 | federal or other external sources of funding for the program, including funding available through |
8 | the state's existing Section 1115 Medicaid Demonstration Waiver, the state's existing Section 1332 |
9 | State Innovation Waiver, or new funding available under those authorities or any other authority. |
10 | (1) The director is authorized to apply for and obtain any available identified funding for |
11 | the program. |
12 | (2) The secretary of the executive office of health and human services is authorized to apply |
13 | for, submit, and negotiate any necessary changes to the Medicaid state plan, the state Section 1115 |
14 | Medicaid Demonstration Waiver, or any other necessary authorities in order to facilitate the |
15 | obtaining of identified funding for the program. |
16 | 42-157.2-4. Establishment of program fund. |
17 | (a) The health insurance individual market affordability fund shall be established to provide |
18 | funding for the operation and administration of the program in carrying out the purposes of the |
19 | program under this chapter. |
20 | (b) The director is authorized to administer the fund. |
21 | (c) The general assembly may appropriate general revenue to support the annual budget |
22 | for the program. |
23 | (d) The fund shall consist of: |
24 | (1) The assessment established by § 42-157.2-5; |
25 | (2) Any federal funding obtained to improve affordability under this chapter; |
26 | (3) Any general revenue appropriated by the general assembly to improve affordability |
27 | under this chapter; and |
28 | (4) Any other money from any other source accepted for the benefit of the fund. |
29 | (e) A restricted receipt account shall be established for the fund which may be used for the |
30 | purposes set forth in this section and shall be exempt from the indirect cost recovery provisions of |
31 | § 35-4-27. |
32 | 42-157.2-5. Health insurance affordability assessment. |
33 | Effective for the 2025 calendar year, there is established a health insurance affordability |
34 | assessment. The assessment amount for 2025 and for each subsequent year shall be set at two |
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1 | percent (2%) of premiums collected by health insurance carriers for health insurance plans issued |
2 | within the state for coverage during the previous calendar year. |
3 | 42-157.2-6. Utilization of program fund -- Affordability programs. |
4 | (a) The director shall allocate the program fund, pursuant to regulations adopted under this |
5 | chapter: |
6 | (1) To provide subsidies to reduce cost sharing for individuals enrolled in health insurance |
7 | coverage through the exchange who are determined eligible for state subsidies; |
8 | (2) To provide payments to carriers to increase the affordability of health insurance on the |
9 | individual market for individuals who receive federal premium tax credits; |
10 | (3) To provide payments to carriers to increase the affordability of health insurance on the |
11 | individual market who are over the household income limit, as established by federal law, for |
12 | federal premium tax credits; and |
13 | (4) To pay for the actual administrative costs for implementing and administering the |
14 | program established under this chapter. These actual administrative costs include the following: |
15 | (i) The costs to implement the market affordability board established by § 42-157.2-7; |
16 | (ii) The actual costs related to implementing and maintaining the assessment established |
17 | by § 42-157.2-5; |
18 | (iii) The costs for conducting analyses necessary to determine the payments to be made to |
19 | carriers for the purposes described in subsections (a)(l), (a)(2), and (a)(3) of this section; and |
20 | (iv) Any other costs which accrue to the state traceable to the operation of this program. |
21 | (b) The program fund shall be allocated as the director, pursuant to recommendations |
22 | established by the board, determines is best in the interest of advancing consumer affordability, |
23 | with the following limitations: |
24 | (1) The director shall appropriate no less than fifty percent (50%) of the program fund |
25 | toward the subsidies to reduce cost sharing established pursuant to subsection (a)(l) of this section; |
26 | (2) The director shall appropriate no more of the program fund toward the carrier payments |
27 | established pursuant to subsection (a)(3) of this section than are appropriated to the carrier |
28 | payments established pursuant to subsection (a)(2) of this section. |
29 | 42-157.2-7. Individual market affordability board. |
30 | (a) There is hereby created the individual market affordability board, which is responsible |
31 | for issuing recommendations to the director for the specific terms of the affordability programs |
32 | established in § 42-157.2-6. |
33 | (b) The board consists of the following voting members: |
34 | (1) The director of the exchange or designee; |
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1 | (2) The commissioner of the office of the health insurance commissioner or designee; |
2 | (3) Eleven (11) additional members as follows: |
3 | (i) One member employed by a carrier; |
4 | (ii) One member who is a representative of a statewide association of health benefit plans; |
5 | (iii) One member representing primary care healthcare providers who does not represent a |
6 | carrier; |
7 | (iv) One member who represents a healthcare advocacy organization; |
8 | (v) One member who is a representative of a business that purchases or otherwise provides |
9 | health insurance coverage for its employees; |
10 | (vi) One member who represents a hospital; |
11 | (vii) Five (5) members who are consumers of healthcare who are not representatives or |
12 | employees of a hospital, carrier, or other healthcare industry entity. To the extent possible, the |
13 | governor shall ensure that the consumer members of the board are individuals who lack affordable |
14 | offers of coverage from their employers and who otherwise struggle to afford to purchase health |
15 | insurance or who struggle to afford to pay for their healthcare. |
16 | (c) The members under subsection (b)(3) of this section shall be appointed by the governor |
17 | and submitted by the governor to the senate, who may within twelve (12) legislative days confirm |
18 | or reject that appointment. If the senate shall fail for twelve (12) legislative days after the |
19 | submission to confirm the appointment, the governor shall submit another appointment and so on |
20 | in like manner until the senate shall confirm the person named by the governor; however, terms of |
21 | current members of the board of review shall not be altered by this chapter. |
22 | (d) To the extent possible, the governor shall attempt to appoint board members who reflect |
23 | the diversity of the state with regard to race, ethnicity, immigration status, income, wealth, |
24 | disability, and geography. |
25 | (e) The term of office of the members of the board appointed by the governor is four (4) |
26 | years, and those members may serve no more than two (2) four (4) year terms |
27 | (f) In order to ensure staggered terms of office, the initial term of office of the members of |
28 | the board is: |
29 | (1) Two (2) years for the members appointed pursuant to subsections (b)(3)(ii), (b)(3)(iii), |
30 | and (b)(3)(iv) of this section and for three (3) of the members appointed pursuant to subsection |
31 | (b)(3)(vii) of this section; and |
32 | (2) Four (4) years for the members appointed pursuant to subsections (b)(3)(ii), (b)(3)(iv), |
33 | and (b)(3)(vi) of this section and for two (2) of the members appointed pursuant to subsection |
34 | (b)(3)(vii) of this section. |
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1 | (g) Members of the board appointed by the governor serve at the pleasure of the governor |
2 | and may be removed by the governor. |
3 | (h) In the case of a vacancy on the board while the senate is in session, the governor shall |
4 | appoint a replacement subject to the provisions of subsection (c) of this section. A member who is |
5 | so appointed to fill a vacancy shall serve the remainder of the unexpired term of the member whose |
6 | vacancy is being filled. |
7 | (i) In the case of a vacancy on the board while the senate is not in session, the governor |
8 | shall appoint a replacement who shall hold office until the beginning of the next session of the |
9 | senate. |
10 | (j) Members of the board may be reimbursed for actual and necessary expenses, including |
11 | any required dependent care and dependent or attendant travel, food, and lodging, while engaged |
12 | in the performance of official duties of the board. |
13 | (k) The board shall meet as often as necessary to carry out its duties. |
14 | (l) The board is authorized to recommend, for approval and establishment by the director |
15 | by rule: |
16 | (1) The timing and methodology for assessing and collecting the assessment established by |
17 | § 42-157.2-5; |
18 | (2) The distribution of program fund revenues allocated for carrier payments and for |
19 | subsidies in a manner that best improves affordability for subsidized populations; |
20 | (3) The parameters, including income limits, for implementing the program and for |
21 | identifying subsidized populations, including: |
22 | (i) The coverage required under state-subsidized individual health coverage plans, which |
23 | coverage shall maximize affordability for qualified individuals; |
24 | (ii) The criteria and procedures for determining whether an individual is a qualified |
25 | individual eligible to enroll in a state-subsidized individual health coverage plan; and |
26 | (iii) The appropriate balance of investment into the subsidies to reduce cost-sharing |
27 | established in § 42-157.2-6(a)(1) and the premium assistance established in §§ 42-157.2-6(a)(2) |
28 | and 42-157.2-6(a)(3). |
29 | 42-157.2-8. Rules and regulations. |
30 | (a) The director may promulgate regulations as necessary to carry out the purposes of this |
31 | chapter. |
32 | (b) In establishing regulations relating to the parameters of the program, the director shall |
33 | consider the recommendations of the board and shall explain in writing the reasons for any |
34 | deviation from the recommendations of the board. |
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1 | SECTION 2. Section 35-4-27 of the General Laws in Chapter 35-4 entitled "State Funds" |
2 | is hereby amended to read as follows: |
3 | 35-4-27. Indirect cost recoveries on restricted receipt accounts. |
4 | Indirect cost recoveries of ten percent (10%) of cash receipts shall be transferred from all |
5 | restricted-receipt accounts, to be recorded as general revenues in the general fund. However, there |
6 | shall be no transfer from cash receipts with restrictions received exclusively: (1) From contributions |
7 | from nonprofit charitable organizations; (2) From the assessment of indirect cost-recovery rates on |
8 | federal grant funds; or (3) Through transfers from state agencies to the department of administration |
9 | for the payment of debt service. These indirect cost recoveries shall be applied to all accounts, |
10 | unless prohibited by federal law or regulation, court order, or court settlement. The following |
11 | restricted receipt accounts shall not be subject to the provisions of this section: |
12 | Executive Office of Health and Human Services |
13 | Organ Transplant Fund |
14 | HIV Care Grant Drug Rebates |
15 | Health System Transformation Project |
16 | Rhode Island Statewide Opioid Abatement Account |
17 | HCBS Support-ARPA |
18 | HCBS Admin Support-ARPA |
19 | Department of Human Services |
20 | Veterans’ home — Restricted account |
21 | Veterans’ home — Resident benefits |
22 | Pharmaceutical Rebates Account |
23 | Demand Side Management Grants |
24 | Veteran’s Cemetery Memorial Fund |
25 | Donations — New Veterans’ Home Construction |
26 | Department of Health |
27 | Pandemic medications and equipment account |
28 | Miscellaneous Donations/Grants from Non-Profits |
29 | State Loan Repayment Match |
30 | Healthcare Information Technology |
31 | Department of Behavioral Healthcare, Developmental Disabilities and Hospitals |
32 | Eleanor Slater non-Medicaid third-party payor account |
33 | Hospital Medicare Part D Receipts |
34 | RICLAS Group Home Operations |
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1 | Commission on the Deaf and Hard of Hearing |
2 | Emergency and public communication access account |
3 | Department of Environmental Management |
4 | National heritage revolving fund |
5 | Environmental response fund II |
6 | Underground storage tanks registration fees |
7 | De Coppet Estate Fund |
8 | Rhode Island Historical Preservation and Heritage Commission |
9 | Historic preservation revolving loan fund |
10 | Historic Preservation loan fund — Interest revenue |
11 | Department of Public Safety |
12 | E-911 Uniform Emergency Telephone System |
13 | Forfeited property — Retained |
14 | Forfeitures — Federal |
15 | Forfeited property — Gambling |
16 | Donation — Polygraph and Law Enforcement Training |
17 | Rhode Island State Firefighter’s League Training Account |
18 | Fire Academy Training Fees Account |
19 | Attorney General |
20 | Forfeiture of property |
21 | Federal forfeitures |
22 | Attorney General multi-state account |
23 | Forfeited property — Gambling |
24 | Department of Administration |
25 | OER Reconciliation Funding |
26 | Health Insurance Individual Market Affordability Fund |
27 | Health Insurance Market Integrity Fund |
28 | RI Health Benefits Exchange |
29 | Information Technology restricted receipt account |
30 | Restore and replacement — Insurance coverage |
31 | Convention Center Authority rental payments |
32 | Investment Receipts — TANS |
33 | OPEB System Restricted Receipt Account |
34 | Car Rental Tax/Surcharge-Warwick Share |
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1 | Grants Management Administration |
2 | RGGI-Executive Climate Change Coordinating Council Projects |
3 | Executive Office of Commerce |
4 | Housing Resources Commission Restricted Account |
5 | Housing Production Fund |
6 | Department of Revenue |
7 | DMV Modernization Project |
8 | Jobs Tax Credit Redemption Fund |
9 | Legislature |
10 | Audit of federal assisted programs |
11 | Department of Children, Youth and Families |
12 | Children’s Trust Accounts — SSI |
13 | Military Staff |
14 | RI Military Family Relief Fund |
15 | RI National Guard Counterdrug Program |
16 | Treasury |
17 | Admin. Expenses — State Retirement System |
18 | Retirement — Treasury Investment Options |
19 | Defined Contribution — Administration - RR |
20 | Violent Crimes Compensation — Refunds |
21 | Treasury Research Fellowship |
22 | Business Regulation |
23 | Banking Division Reimbursement Account |
24 | Office of the Health Insurance Commissioner Reimbursement Account |
25 | Securities Division Reimbursement Account |
26 | Commercial Licensing and Racing and Athletics Division Reimbursement Account |
27 | Insurance Division Reimbursement Account |
28 | Historic Preservation Tax Credit Account |
29 | Marijuana Trust Fund |
30 | Social Equity Assistance Fund |
31 | Judiciary |
32 | Arbitration Fund Restricted Receipt Account |
33 | Third-Party Grants |
34 | RI Judiciary Technology Surcharge Account |
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1 | Department of Elementary and Secondary Education |
2 | Statewide Student Transportation Services Account |
3 | School for the Deaf Fee-for-Service Account |
4 | School for the Deaf — School Breakfast and Lunch Program |
5 | Davies Career and Technical School Local Education Aid Account |
6 | Davies — National School Breakfast & Lunch Program |
7 | School Construction Services |
8 | Office of the Postsecondary Commissioner |
9 | Higher Education and Industry Center |
10 | IGT STEM Scholarships |
11 | Department of Labor and Training |
12 | Job Development Fund |
13 | Rhode Island Council on the Arts |
14 | Governors’ Portrait Donation Fund |
15 | Statewide records management system account |
16 | SECTION 3. This act shall take effect upon passage. |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO STATE AFFAIRS AND GOVERNMENT -- RHODE ISLAND INDIVIDUAL | |
MARKET AFFORDABILITY ACT OF 2024 | |
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1 | This act would create the Rhode Island Individual Market Affordability Act of 2024 to help |
2 | reduce out-of-pocket costs for low- and moderate-income consumers enrolled in the health |
3 | insurance exchanges. |
4 | This act would take effect upon passage. |
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